Management of Heparin-Induced Thrombocytopenia: A Contemporary Review.
Jun Yen NgMelanie D'SouzaFelanita HutaniPhilip Young-Ill ChoiPublished in: Journal of clinical medicine (2024)
Heparin-induced thrombocytopenia (HIT) is a life- and limb-threatening immune-mediated emergency classically associated with heparin therapy. This review focuses on type II HIT, characterized by the development of antibodies against platelet-factor 4 (PF4) bound to heparin after exposure, causing life-threatening thrombocytopenia, arterial thrombosis, and/or venous thrombosis. The high morbidity and mortality rates emphasize the need for early recognition and urgent intervention with discontinuation of heparin and initiation of non-heparin anticoagulation. We discuss the management of HIT with an emphasis on recent developments: (i) incorporating the phases of HIT (i.e., suspected, acute, subacute A and B, and remote) into its management, categorized according to platelet count, immunoassay, and functional assay results and (ii) direct-acting oral anticoagulants (DOACs), which are increasingly used in appropriate cases of acute HIT (off-label). In comparison to parenteral options (e.g., bivalirudin and danaparoid), they are easier to administer, are more cost-effective, and obviate the need for transition to an oral anticoagulant after platelet recovery. We also identify the knowledge gaps and suggest areas for future research.
Keyphrases
- venous thromboembolism
- growth factor
- direct oral anticoagulants
- atrial fibrillation
- drug induced
- liver failure
- pulmonary embolism
- healthcare
- oral anticoagulants
- high glucose
- public health
- respiratory failure
- diabetic rats
- aortic dissection
- stem cells
- hepatitis b virus
- percutaneous coronary intervention
- acute coronary syndrome
- peripheral blood
- smoking cessation
- extracorporeal membrane oxygenation
- mechanical ventilation
- quantum dots